The Physical Therapy Efficacy Index and Chart: a stimulus for value-based healthcare using real-world data. A mixed methods study

Abstract

Background Health care costs are rising rapidly in Western societies. Understanding the benefits and costs of care is crucial to maintaining or improving existing health care systems. We propose an instrument that provides a clear overview of both the costs and returns of a treatment to improve the quality of care while keeping the costs affordable. Methods First, a general value-based healthcare concept was developed as an efficacy index. Second, a Physiotherapy-specific Efficacy Index (PE-_Index) for musculoskeletal disorders was formulated based on pain and functional improvement, treatments, and episode duration. The PE-_Index 's discriminative value was assessed using a linear mixed model with physiotherapy practices as a random effect in real-world data from a national registry. Variation attributed to practices was quantified by an intraclass correlation coefficient. Separate linear mixed models and a radar plot (PE-_Graph) visualized individual PE-_Index components. Lastly, stakeholders evaluated the PE-_Index and PE-_Graph for internal quality improvement and external transparency through surveys and advisory board meetings. Results In total, 95.805 episodes treated in 370 practices were included in the linear mixed models. The PE-_Index demonstrated an adequate discriminative ability with an ICC of 0.118. Stakeholders agree that the PE-_Index and the PE-_Chart are appropriate for improvement of quality of care and enhancing the current system for external transparency. Nevertheless, because of concerns about a too hasty implementation and the risk of strategic gaming, both were not considered suitable for external transparency right now. Conclusions The PE-_Index and PE-_Graph are adequate instruments to discriminate between practices and can be used for internal quality improvement, however, are not yet suitable for external transparency purposes.